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General NPI Number Information
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NPI Number | 1174244362
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Entity Type | Organization
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Legal Business Name | MIA HEALTH INC.
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 5680 KING CENTRE DR STE 600
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City | KINGSTOWNE
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State | VA
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Zip | 22315-5755
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Country | US
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Telephone | 571-408-9904
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Fax |
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Provider Business Mailing Address
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Address Line | 4188 LA MAURICIE LOOP
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City | DUMFRIES
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State | VA
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Zip | 22025-1953
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Country | US
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Telephone | 703-380-6204
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Fax |
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Authorized Official
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Title or Position | COO
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Name | GRISELDA SHUTERMEJA
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Credential |
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Telephone | 703-380-6204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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